We would like to sound a caution about relying on abstracts;

One writer to this list recently wrote, “…often we just rely on abstracts of peer-reviewed journals…” as a way to quickly obtain (and advise other clinicians) about the medical literature." 

It might be worthwhile to point out that there is danger in using abstracts to solve the time crunch problem all clinicians run into when needing valid, relevant information during the work day.  

We often shock physicians into reading differently when we tell them about the Pitkin study (Pitkin et al., JAMA, 1999) which reported that 18-68% of abstracts in top journals (Ann Intern Med, BMJ, JAMA, Lancet and NEJM) contained information inconsistent with data in the article or not found at all in the body of the article.  Abstracts may be useful in helping to decide whether or not to discard a study, but information in abstracts may be incorrect. 

Worse, there is no way to tell if an article is relevant or valid from looking at the abstract.   During our programs, we shock physicians even more by showing them powerful examples of harms caused by studies applied without a critical reading to find the flaws. 

We have huge problems with healthcare quality and cost often as a result of doing the wrong thing or not doing the right thing, not doing the right thing right, etc.   Respectfully, I submit that – while very well intentioned – a service that suggests to people that they are getting valid information from review of abstracts is misleading.

Critical appraisal skills don’t have to come by agony.  We have developed a powerful, yet fun, method to teach people the needed skills to get them very far along the EBM pathway in a very short period of time.  It doesn’t take doing an entire systematic review to understand weaknesses in study types, frequently found biases, understanding confounding, etc.

 These skills should be considered a core competency for all physicians.  We would never expect that a physician not know something basic like anatomy or sterile technique because it takes time.  Basic critical appraisal skills should be a requirement. 

 Another option is to subscribe to one of the ever-increasing “formularies of evidence” such as Clinical Evidence, a collection of systematic reviews with additional reviews of RCTs that is updated every 6 months and comes with a CD, or the systematic reviews done by Cochrane.   

 We each have a responsibility to get these skills if they weren’t taught us if we are to live up to our commitment to, “Do no harm.”

Michael Stuart MD
President, Delfini Group, LLC
Clinical Assistant Professor, UW School Medicine
6831 31st Ave. N.E.
Seattle, WA 98115
206-854-3680

Sheri Strite, Associate DirectorProgram Development, Department of Family and Preventive Medicine
UCSD School Medicine